Relentless Health Value

Kimberly Carleson, CEO of US Beacon, shares her expertise in payment integrity and the challenges of medical billing. She reveals the staggering prevalence of billing errors and their impact on healthcare costs. Kimberly emphasizes the necessity of third-party audits to catch inaccuracies and the importance of transparent communication in billing practices. She also discusses the rights of plan sponsors under various regulations and offers strategies for navigating complex medical billing systems, ultimately advocating for fairer costs and enhanced compliance.

Exploring the Complexities of Pharma Rebates with Ann Lewandowski In this Summer Short episode of Relentless Health Value, host Stacey Richter converses again with Ann Lewandowski about the intricate dynamics of pharmaceutical rebates, or as Lewandowski prefers, post-sale concessions. The discussion delves into the nuances of these rebates, the impact they have on drug costs, and the hidden consequences for patients and plan sponsors. They highlight articles and insights by Austin Chelko and Peter Hayes, touching on how rebates can disadvantage the pursuit of lower-cost generics and biosimilars, and can obstruct pharmacogenetic testing that ensures drug efficacy and safety. The conversation also critiques the opacity of rebates, deemed trade secrets by pharma and PBM companies, and underscores the ethical and financial dilemmas posed by the current rebate-driven system. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP480 ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe 🫙 Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b === CONNECT WITH THE RHV TEAM === ✭ LinkedIn https://www.linkedin.com/company/relentless-health-value/ ✭ Threads https://www.threads.net/@relentlesshealthvalue/ ✭ Bluesky https://bsky.app/profile/relentleshealth.bsky.social ✭ X https://twitter.com/relentleshealth/ 07:24 What is a pharmaceutical rebate? 08:15 Why are pharma rebates so opaque? 09:52 Texas lawsuit on insulin pricing. 10:18 Why is focusing on a singular type of concession difficult with current pharma rebate structures? 10:50 EP397 with Paul Holmes. 13:55 EP353 with Pramod John, PhD. 14:29 How does pharma genomics testing affect pharma rebates? 14:52 EP465 with Chris Crawford. 15:52 EP426 with Nina Lathia, RPh, MSc, PhD.

Join Jon Camire, Managing Director and CFO at Equity Healthcare, and Andreas Mang, Senior Managing Director at Blackstone, as they delve into the complexities of stop-loss reinsurance for high-cost claimants. They discuss best practices for avoiding overpayment, the necessity of thorough contract reviews, and the significance of engaging expert brokers. The conversation highlights vital considerations for plan sponsors, including eligibility audits and financial risks, ensuring a comprehensive strategy to manage healthcare coverage effectively.

In a thought-provoking discussion, Justin Leader, CEO of BenefitsDNA, dives into the murky waters of third-party administrators (TPAs) and their impact on healthcare costs. He sheds light on hidden fees buried within weekly claims wires, including shared savings and pay and chase fees. Justin emphasizes the pressing need for transparency and fiduciary responsibility among self-funded employers. With references to ongoing legal cases and insights from Health Affairs, he urges listeners to scrutinize TPA contracts for a clearer understanding of their true costs.

In this engaging discussion, Andreas Mang, Senior Managing Director at Blackstone and CEO of Equity Healthcare, teams up with Jon Camire to shed light on stop-loss coverage in healthcare. They define what stop-loss insurance is and how it shields self-insured employers from hefty financial setbacks. The duo emphasizes the importance of expert consultants and dives into individual versus aggregate policies, exploring crucial strategies for managing high-cost claimants. A must-listen for those navigating the intricate world of self-insurance!

In this episode, Stacey Richter explores the impact of trust on healthcare outcomes, drawing from listener contributions and prior episodes of Relentless Health Value. The discussion underscores how trust or the lack thereof affects patients, clinicians, and healthcare systems. Key points include the importance of building trusted relationships, the detrimental effects of antitrust behaviors, and the broader implications for healthcare delivery. Stacey also highlights a bonus show featuring Charles Green on earning and maintaining trust. The episode concludes with an uplifting message about the collaborative and giving nature of the Relentless Health Value community. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP477 🔗 Bonus Show - Show Notes https://cc-lnk.com/Bonus477: ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe 🫙 Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === ✭ LinkedIn https://www.linkedin.com/company/relentless-health-value/ ✭ Threads https://www.threads.net/@relentlesshealthvalue/ ✭ Bluesky https://bsky.app/profile/relentleshealth.bsky.social ✭ X https://twitter.com/relentleshealth/ 00:47 What is the new, emerging through line becoming apparent in healthcare? 01:54 Bonus Episode with Charles Green. 02:52 What is the impact of trust in healthcare? 02:55 EP475 with Peter Hayes. 03:11 EP473 with Kenny Cole, MD. 05:31 EP295 with Rebecca Etz, PhD. 06:07 EP326 with Rishi Wadhera, MD, MPP. 07:06 Why does trust grow through proximity, and why do providers need to integrate this into care models? 07:59 Why antitrust is so prevalent in healthcare. 10:00 What are two main contributors to the lack of primary care doctors? 13:27 Why collaboration builds trust.

In this bonus add-on to episode 477 of Relentless Health Value, host Stacey Richter revisits a decade-old conversation with trust expert Charles Green, founder of Trusted Advisor Associates. Green discusses the intricacies of building and maintaining trust in healthcare, emphasizing four key trust principles: client focus, collaboration, long-term relationships, and transparency. The discussion highlights the challenges within the healthcare industry, compounded by conflicts of interest and transactional dynamics. Green underscores the importance of individual actions and leadership in fostering trust, advocating for empathetic listening and genuine curiosity about others as foundational behaviors. === LINKS === 🔗 Show Notes with all mentioned links: https://relentlesshealthvalue.com/episodes ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe 🫙 Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe 🎤 Listen on Apple Podcastshttps://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === ✭ LinkedIn https://www.linkedin.com/company/relentless-health-value/ ✭ Threads https://www.threads.net/@relentlesshealthvalue/ ✭ Bluesky https://bsky.app/profile/relentleshealth.bsky.social ✭ X https://twitter.com/relentleshealth/ 01:45 Four trust principles that can help you earn your clients trust and come off as more trustworthy from first impressions onward. 04:31 Charles's words of wisdom for rebuilding lost trust. 05:46 Where does trusted leadership start? 06:38 Why trust in leadership is about embodying trust in actions, not words. 07:26 Why does personality have an outsized impact in leadership and trust? 08:21 "If we want to improve our trust, we just simply need to work on ourselves." 08:56 Why listening with a sense of curiosity and respect drives reciprocal behavior and improves trust. 09:14 What is the best technique to immediately improve your trust relationship?

In this episode, host Stacey Richter speaks with Ann Lewandowski about whistleblowing in the healthcare industry, focusing on a significant case involving a whistleblower at an employee benefit consultant (EBC) firm. This EBC allegedly pocketed their clients' pharma rebates, violating the Consolidated Appropriations Act of 2021. The discussion highlights the nuances of being a whistleblower, the ethical dilemmas faced, compliance challenges, and the significant financial implications for companies and individuals involved in illegal activities. Ann Lewandowski provides insights into documenting and protecting oneself legally and discusses the broader context of trust and transparency in the healthcare sector. Click through to the show notes below to access all of the mentioned links and prior episodes mentioned. === LINKS === 🔗 Show Notes with all mentioned links: https://relentlesshealthvalue.com/episodes ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe 🫙 Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === ✭ LinkedIn https://www.linkedin.com/company/relentless-health-value/ ✭ Threads https://www.threads.net/@relentlesshealthvalue/ ✭ Bluesky https://bsky.app/profile/relentleshealth.bsky.social ✭ X https://twitter.com/relentleshealth/ 08:10 What does it mean to be a whistleblower? 09:05 What's happening in the current whistleblower case about pharma rebates? 14:24 What are the disclosure requirements, and how does this affect contracts in healthcare? 15:05 EP379 with AJ Loiacono. 15:11 The 5500 form. 15:36 EP397 with Paul Holmes. 16:46 Why having a "defensive health plan" is important. 17:31 Matt Ohrt's post about healthcare's soul. 17:42 Michelle Bernabe's post about how healthcare has lost its heart. 18:15 Why "trust and verify" is important when building contracts and relationships in healthcare. 18:42 Quote by W. Edwards Deming. 21:35 How has this case moved from state to federal court? 23:30 Whistleblower case on generic drug collusion. 24:01 What is a qui tam lawsuit? 28:08 What is an Upjohn warning and the issue of corporate Miranda rights? 30:01 What is Ann's advice to employees who might be whistleblowers? 31:41 EP438 with John Lee, MD. 33:31 What are some red flags that employees should look for to understand what kind of company they work for?

In this episode of Relentless Health Value, host Stacey Richter sits down with Peter Hayes to discuss the major forces driving change in the healthcare industry. Hayes outlines three critical factors: changing public opinion, heightened transparency, and new regulations such as the Consolidated Appropriations Act. He emphasizes the unprecedented convergence of these elements, creating a pivotal moment for healthcare transformation. The discussion delves into the erosion of trust within the healthcare system and the growing public unrest over high costs and inefficiencies. Hayes also highlights the role of state-level initiatives as experimental laboratories for potential national solutions. The episode concludes with a call to focus on root causes and collaborative approaches to restore trust and improve healthcare affordability and quality. === LINKS === 🔗 Show Notes with all mentioned links: https://relentlesshealthvalue.com/episodes ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe 🫙 Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === ✭ LinkedIn https://www.linkedin.com/company/relentless-health-value/ ✭ Threads https://www.threads.net/@relentlesshealthvalue/ ✭ Bluesky https://bsky.app/profile/relentleshealth.bsky.social ✭ X https://twitter.com/relentleshealth/ 05:28 What things are adding to the urgency in this moment of healthcare? 05:55 The three things that have brought us to a tipping point in healthcare. 07:05 Why is now the real moment for this tipping point? 10:35 EP458 with Komal Bajaj, MD. 13:01 Article by (and tribute to) Uwe Reinhardt. 13:27 Hospital ratings by The Leapfrog Group. 14:08 EP358 with Wayne Jenkins, MD. 15:07 EP474 with Yashaswini Singh, PhD. 16:29 How is regulation changing in healthcare? 21:48 How the "trifecta" of change is working together to create this movement of change in healthcare. 23:54 What do we need to look at to address the problems pushing this change in healthcare? 25:44 EP465 with Chris Crawford. 30:04 Why is federal and state collaboration going to be important to this healthcare change? 31:51 EP455 with Beau Raymond, MD.

In Episode 474 of 'Relentless Health Value', host Stacey Richter interviews Dr. Yashaswini Singh, an economist and assistant professor at Brown University, about the growing influence of private equity (PE) in healthcare. The conversation delves into the corporate transformation of medicine, highlighting the potential misalignment between business interests and patient care. Dr. Singh discusses the diverse strategies PE firms use to drive profitability, such as increasing negotiated prices, consolidating market share, employing real estate leasebacks, and emphasizing performance metrics that may not align with patient benefits. The episode also examines the significant impacts these strategies have on physicians, including increased turnover and changes in practice patterns, as well as the broader implications for patients and communities. Dr. Singh stresses the importance of informed leadership, education, policy enforcement, and transparency to ensure that private investments ultimately benefit healthcare systems without compromising patient care. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP474 ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe 🫙 Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === ✭ LinkedIn https://www.linkedin.com/company/relentless-health-value/ ✭ Threads https://www.threads.net/@relentlesshealthvalue/ ✭ Bluesky https://bsky.app/profile/relentleshealth.bsky.social ✭ X https://twitter.com/relentleshealth/ 05:53 What is the tension between business and medicine? 07:05 What is the impact of private equity on healthcare? 08:46 How does healthcare change when private equity invests in medical facilities? 10:54 What are the intuitive impacts of private equity in healthcare? 12:28 What are the less intuitive effects of private equity on healthcare? 13:36 EP472 with Eric Bricker, MD. 14:15 What are the misconceptions about private equity investors acquiring healthcare facilities? 16:17 The Steward saga. 16:24 The death of Hahnemann Hospital in Philadelphia. 19:27 Are there any positive outcomes to private equity investment in healthcare? 21:17 EP445 with Tom X. Lee, MD. 22:45 EP420 with Ge Bai, PhD, CPA. 22:47 EP465 with Chris Crawford. 22:49 EP460 with Rushika Fernandopulle, MD. 22:55 Is there ever a need for private investment in healthcare? 25:40 How do the changes private equity firms create affect patients? 27:20 Study in Health Affairs on physician turnover rates following private equity acquisitions. 29:30 How can private equity disrupt physician employment as well? 34:13 What remedies might there be for consolidation in healthcare and private equity investing in medicine?